Work Activity Inspection (Confined Space)

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Safe Working in a Confined Space

• Has the Apprentice/Trainee completed nationally recognized training and been issued with a statement of attainment.

  Yes

  No

  N/A

• Are confined spaces entered within a safe oxygen range (19.5 - 23.5) without respiratory protection?

  Yes

  No

  N/A

• Are confined spaces entered in an oxygen deficient atmosphere (below 19.5) & using breathing apparatus?

  Yes

  No

  N/A

• Is the oxygen level in confined spaces tested prior to entry using multi gas detection and oxygen monitoring devices?

  Yes

  No

  N/A

• Is a stand by person always assigned to remain on the outside and capable of initiating emergency response procedures?

  Yes

  No

  N/A

• Is there written authority in place which permits entry and/ or work in the confined space?<br>(Entry permit, permit to work)

  Yes

  No

  N/A

• Will the AiGTS Apprentice/Trainee be supervised by a person who is competent and has been trained to work in a confined space?

  Yes

  No

  N/A

• Are safe work procedures in place and a systematic approach to working in a confined space?

  Yes

  No

  N/A

• Do the safe work procedures include emergency response?

  Yes

  No

  N/A

AiGTS

• Is the work activity to be prohibited for AiGTS Apprentices/Trainees?

  Yes

  No

  N/A

• Have the findings been discussed with the Host Company?

  Yes

  No

  N/A

• Did the inspection result in any further actions?

  Yes

  No

  N/A

Corrective actions/Comments:

• Host or Apprentice

  Sign

• AiGTS Representative

  Sign